AB195. SOH25_AB_262. Testicular Leydig cell tumors: balancing risks and patient concerns—a case series

Background: Leydig cell tumors are rare non-germinal testicular tumors, representing 1–3% of all testicular neoplasms. Most are benign, but 10% may be malignant. The absence of reliable preoperative diagnostic tools poses challenges in patient management, especially when radical orchidectomy is required for definitive diagnosis.

Case Description: We present two cases of middle-aged men who presented with testicular masses and intermittent pain. While imaging identified a lesion and was concerned for a possible malignancy, it wasn’t conclusive for malignancy and with tumor markers being normal. Both patients delayed surgical intervention for more than 6 months, concerned about the possibility of benign histology. Medical decision making census was to offer radical orchidectomy for both. Extensive counselling was required. Both patients underwent radical orchidectomy after several follow-up consultations and interval imaging, and histopathological report confirmed benign Leydig cell tumors with no evidence of malignancy. Postoperative recovery was uneventful, and the patients were reassured of their favorable prognosis.

Conclusions: These cases underscore the diagnostic and psychological complexities in managing rare testicular tumors. Leydig cell tumors, though predominantly benign, necessitate surgical intervention due to the risk of malignancy, as preoperative tools cannot reliably differentiate between benign and malignant forms. Patient-centered counselling and shared decision-making are vital in addressing management hesitations. Further research is needed to improve diagnostic approaches and reduce unnecessary radical procedures in benign cases.

Keywords: Leydig cell tumors; testicular neoplasms; testicular pain; case series; reinke crystals